There is emerging consensus that measures of quality and resource use/cost are critical to efforts to improve the value of healthcare services. Amid the seemingly inexorable rise of health care costs, increasing attention is being focused on waste and inefficiency. In its seminal report, Crossing the Quality Chasm, the Institute of Medicine included efficiency as one of the six critical aims for the health care system. The IOM defined efficiency as benefit derived per unit of cost, or cost for a given level of benefit, and placed a strong focus on measuring and eliminating waste, overuse and misuse. More recently, the National Priorities Partnership (NPP), coordinated by the National Quality Forum (NQF), issued a very cogent and well articulated roadmap identifying overuse and waste as one of the most prominent and compelling measurement needs facing the health care system. The National Committee for Quality Assurance (NCQA), in collaboration with the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement(r) (PCPI) and in consultation with others including NQF, proposes to convene a working meeting to address the measurement gaps in overuse and appropriateness of care. The goals of the meeting and related activities are: 1) To create a framework to guide the development and implementation of measures of overuse and appropriateness in practice settings for both internal quality improvement and external reporting in conjunction with other measures of quality. 2) To identify, using the NPP priorities as a starting point, specific content areas for initiation of measure development as well as potential sites or organizations for future testing and implementation of measures. This project will complements AHRQ's current interest areas related to health information technology (HIT), comparative effectiveness and prevention/management of complex patients. As a result of the conference, we will prepare an issue brief intended for publication that will outline a framework for measuring appropriateness of care and overuse, identify priorities for measure development, and suggesting solutions for overcoming implementation barriers. Additionally, the issue brief will highlight needs for future research. The proposed conference date is May 2009.